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. 2004 Dec 1;39(11):1642-50.
doi: 10.1086/425615. Epub 2004 Nov 8.

The burden of community-acquired pneumonia in seniors: results of a population-based study

Michael L Jackson  1 , Kathleen M Neuzil, William W Thompson, David K Shay, Onchee Yu, Christi A Hanson, Lisa A Jackson
Affiliations

The burden of community-acquired pneumonia in seniors: results of a population-based study

Michael L Jackson et al. Clin Infect Dis. .

Abstract

Background: Pneumonia is recognized as a leading cause of morbidity in seniors. However, the overall burden of this disease--and, in particular, the contribution of ambulatory cases to that burden--is not well defined. To estimate rates of community-acquired pneumonia and to identify risk factors for this disease, we conducted a large, population-based cohort study of persons aged >or=65 years that included both hospitalizations and outpatient visits for pneumonia.

Methods: The study population consisted of 46,237 seniors enrolled at Group Health Cooperative who were observed over a 3-year period. Pneumonia episodes presumptively identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes assigned to medical encounters were validated by medical record review. Characteristics of participants were defined by administrative data sources.

Results: The overall rate of community-acquired pneumonia ranged from 18.2 cases per 1000 person-years among persons aged 65-69 years to 52.3 cases per 1000 person-years among those aged >or=85 years. In this population, 59.3% of all pneumonia episodes were treated on an outpatient basis. In multivariate analysis, risk factors for community-acquired pneumonia included age, male sex, chronic obstructive pulmonary disease, asthma, diabetes mellitus, congestive heart failure, and smoking.

Conclusions: On the basis of these data, we estimate that roughly 915,900 cases of community-acquired pneumonia occur annually among seniors in the United States and that approximately 1 of every 20 persons aged >or=85 years will have a new episode of community-acquired pneumonia each year.

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Figures

Table A1
Table A1
Definition of baseline covariates.
Table 1
Table 1
Baseline characteristics of study subjects, by age group
Table 2
Table 2
Rates of community-acquired pneumonia (CAP) and the proportion of patients hospitalized, by age group, during the study period.
Figure 1
Figure 1
Biweekly rates of all cases of community-acquired pneumonia (CAP) among seniors in Group Health Cooperative (GHC), including hospitalizations and outpatient visits for CAP, during the study period. Periods of influenza virus circulation, as defined by Centers for Disease Control and Prevention surveillance data, are shaded [7–10]. For comparison, the biweekly proportion of all deaths in the United States attributed to pneumonia and influenza (P&I), as reported by national vital statistics data, is also presented [6].
Table 3
Table 3
Results of multivariate Cox proportional analyses of time to first event for the outcomes of chart review-confirmed hospitalizations for community-acquired pneumonia (CAP), outpatient visits for CAP, and all CAP.
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References

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